Healthcare Provider Details

I. General information

NPI: 1235711078
Provider Name (Legal Business Name): CHIDINMA ONYINYE UKADIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 DOGWOOD DR SE
CONYERS GA
30013-5088
US

IV. Provider business mailing address

1478 DOGWOOD DR SE
CONYERS GA
30013-5088
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone: 404-365-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111887
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number111887
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74576
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74576
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: